The clinical effect of digital cognitive behavioural therapy for insomnia in subgroups with depressive and anxiety symptoms: A secondary analysis of a randomized-controlled trial.

Insomnia is a highly prevalent mental disorder, and is often co-occurring with depression and anxiety disorders. Cognitive behavioural therapy for insomnia as treatment of choice for insomnia can also be applied digitally (digital cognitive behavioural therapy for insomnia), making it more accessible. This is a secondary data analysis of a two-armed parallel randomized-controlled trial. In the primary publication, N = 238 participants meeting criteria for the 5th edition of Diagnostic and Statistical Manual of Mental Disorders chronic insomnia disorder were randomly assigned to either 8 weeks of digital cognitive behavioural therapy for insomnia + treatment-as-usual, or waitlist + treatment-as-usual. To determine the clinical effects of digital cognitive behavioural therapy for insomnia in populations with comorbid anxiety and depression symptoms, this secondary analysis focused on two subgroups: (1) participants with high initial depressive symptoms; and (2) participants with high initial anxiety symptoms. Symptoms of insomnia, depression and anxiety as primary outcome measures were obtained at baseline, 8 weeks post-randomization and, in the intervention group only, at 6- and 12-months follow-up. At 8 weeks post-randomization, the use of digital cognitive behavioural therapy for insomnia in both subgroups was associated with large reductions in insomnia severity in comparison to control (depression subgroup: d = 2.37; anxiety subgroup: d = 2.13). Between-group treatment effects were also observed for symptoms of depression in the depression subgroup (d = 1.59), and for symptoms of anxiety in the anxiety subgroup (d = 1.28). Within-group effects were stable over time (d = 0.64-1.63). This secondary analysis shows that digital cognitive behavioural therapy for insomnia reduces insomnia and comorbid symptoms in participants with high initial symptoms of either depression or anxiety with sustained long-term effects.

Anodal Transcranial Direct Current Stimulation (atDCS) of the Primary Motor Cortex (M1) Facilitates Nonconscious Error Correction of Negative Phase Shifts.

Accurate motor timing requires the temporally precise coupling between sensory input and motor output including the adjustment of movements with respect to changes in the environment. Such error correction has been related to a cerebello-thalamo-cortical network. At least partially distinct networks for the correction of perceived (i.e., conscious) as compared to nonperceived (i.e., nonconscious) errors have been suggested. While the cerebellum, the premotor, and the prefrontal cortex seem to be involved in conscious error correction, the network subserving nonconscious error correction is less clear. The present study is aimed at investigating the functional contribution of the primary motor cortex (M1) for both types of error correction in the temporal domain. To this end, anodal transcranial direct current stimulation (atDCS) was applied to the left M1 in a group of 18 healthy young volunteers during a resting period of 10 minutes. Sensorimotor synchronization as well as error correction of the right index finger was tested immediately prior to and after atDCS. Sham stimulation served as control condition. To induce error correction, nonconscious and conscious temporal step-changes were interspersed in a sequence of an isochronous auditory pacing signal in either direction (i.e., negative or positive) yielding either shorter or longer intervals. Prior to atDCS, faster error correction in conscious as compared to nonconscious trials was observed replicating previous findings. atDCS facilitated nonconscious error correction, but only in trials with negative step-changes yielding shorter intervals. In contrast to this, neither tapping speed nor synchronization performance with respect to the isochronous pacing signal was significantly modulated by atDCS. The data suggest M1 as part of a network distinctively contributing to the correction of nonconscious negative step-changes going beyond sensorimotor synchronization.

The influence of anodal transcranial direct current stimulation over the right auditory cortex on interference effects in memory for melodies.

The study investigates how transcranial direct current stimulation (tDCS) over the auditory cortex (AC) modulates memory for melodies under different noise conditions, whilst also considering cumulative disruptive interference effects. Forty-one participants completed a continuous recognition melody task, as well as a visual control task, which included four noise conditions for which noise was either present only during encoding (N-C), only during retrieval (C-N), during both (N-N) or not at all (C-C) and completed the tasks after receiving anodal or sham tDCS over the right AC. The results of the sham session replicate previous findings by revealing that memory for melodies is worse when noise in added to the encoding phase (N-C) whereas the N-N condition shows good performance, highlighting a context effect, and that cumulative disruptive interference is not present in memory for melodies except in the N-C condition. After anodal stimulation the memory pattern differs such as that memory performance is best in the C-C condition and furthermore the cumulative disruptive interference effect in the N-C condition is diminished. In sum, the study highlights the involvement of the right AC for memory for melodies and the results indicate an association of the AC for creating context effects.

Right parietal cortex mediates recognition memory for melodies.

Functional brain imaging studies have highlighted the significance of right-lateralized temporal, frontal and parietal brain areas for memory for melodies. The present study investigated the involvement of bilateral posterior parietal cortices (PPCs) for the recognition memory of melodies using transcranial direct current stimulation (tDCS). Participants performed a recognition task before and after tDCS. The task included an encoding phase (12 melodies), a retention period, as well as a recognition phase (24 melodies). Experiment 1 revealed that anodal tDCS over the right PPC led to a deterioration of overall memory performance compared with sham. Experiment 2 confirmed the results of Experiment 1 and further showed that anodal tDCS over the left PPC did not show a modulatory effect on memory task performance, indicating a right lateralization for musical memory. Furthermore, both experiments revealed that the decline in memory for melodies can be traced back to an interference of anodal stimulation on the recollection process (remember judgements) rather than to familiarity judgements. Taken together, this study revealed a causal involvement of the right PPC for memory for melodies and demonstrated a key role for this brain region in the recollection process of the memory task.

The relation between awareness of personal resources and metabolic control in children and adolescents with type 1 diabetes.

INTRODUCTION: The study aims to elucidate whether awareness of personal resources, such as positive attributions and beliefs or social support, affects metabolic control in children and adolescents with type 1 diabetes. In addition, it will be determined to what extent metabolic control is influenced by concordance between children and parents regarding awareness of resources and the parents' ability to adopt their children's perspective. Also, the children's wishes particularly in relation to their illness will be investigated, as well as the kind of advice they would offer to fellow patients. METHODS: Seventy-eight children/adolescents with type 1 diabetes completed the Essen Resource Inventory for Children and Adolescents including personal, social, structural, and migration-specific resources. In addition, children/adolescents and their parents completed a systemic-oriented, diabetes-specific resource questionnaire in order to explore the parents' ability to adopt their children's perspective. RESULTS: Resources such as body awareness and open-minded attitude to the disease were associated with metabolic control. Particularly, resources associated to a migration background were found to be inversely correlated with hemoglobin A1c (HbA1c) value. Moreover, it was shown that the parents' ability to adopt their children's perspective was associated with improved metabolic control. Children advising fellow patients to accept the disease showed the best HbA1c value. DISCUSSION: This data identified specific modifiable factors related to metabolic control that can be addressed during counseling of pediatric patients. Also the parents' ability for adopting their child's perspective was identified as a relevant factor which should be considered during clinical counseling of young type 1 diabetes patients.

Cathodal high-definition transcranial direct current stimulation (HD-tDCS) of the left ventral prefrontal cortex (vPFC) interferes with conscious error correction.

Precise motor timing requires the ability to flexibly adapt one's own movements with respect to changes in the environment. Previous studies suggest that the correction of perceived as compared to non-perceived timing errors involves at least partially distinct brain networks. The dorsolateral prefrontal cortex (dPFC) has been linked to the correction of perceived timing errors and evidence for a contribution of the ventrolateral PFC (vPFC) specifically to the correction of non-perceived errors exists. The present study aimed at clarifying the functional contribution of the left vPFC for the correction of timing errors by adopting high-definition transcranial direct current stimulation (HD-tDCS). Twenty-one young healthy volunteers synchronized their right index finger taps with respect to an isochronous auditory pacing signal. Perceivable and non-perceivable step-changes of the metronome were interspersed, and error correction was analyzed by means of the phase-correction response (PCR). In subsequent sessions anodal and cathodal HD-tDCS was applied to the left vPFC to establish a brain-behavior relationship. Sham stimulation served as control condition. Synchronization accuracy as well as error correction were determined immediately prior to and after HD-tDCS. The analysis suggests a detrimental effect of cathodal HD-tDCS distinctively on error correction in trials with perceived timing errors. The data support the significance of the left vPFC for error correction in the temporal domain but contradicts the view of a role in the correction of non-perceived errors.

Increased sensory feedback in Tourette syndrome.

Tourette syndrome (TS) is a neuro-psychiatric disorder being characterized by motor and phonic tics typically preceded by sensory urges. Given the latter the role of the sensory system and sensorimotor interaction in TS has recently gained increased attention. 12 TS patients and 12 matched control subjects performed two tasks, requiring simple finger movements: a Go/NoGo task and a self paced movement task. Neurophysiological data was recorded using magnetoencephalography (MEG). Event related responses around movement onset, i.e. motor field (MF) occurring directly prior to the movement and movement evoked field (MEF) immediately after movement onset were analyzed using dipole modeling. MF peak amplitudes did not differ between groups in either task. In contrast, in both tasks MEF peak amplitudes were increased in TS patients. Moreover, larger MEF amplitudes during self paced movements were inversely correlated with motor tic frequency and severity. Enlarged MEF amplitudes as a marker of early sensory feedback of one's own movements probably represent enlarged sensory input from the periphery resulting from altered subcortical gating. We conclude that TS patients exhibit altered sensory-motor processing involved in voluntary movement control, which might also be successful in tic control.

Echoes from childhood--imitation in Gilles de la Tourette Syndrome.

BACKGROUND: Tourette syndrome patients are reported to show automatic imitation (echopraxia), but this has not yet been proven experimentally. METHODS: Video clips showing either tics of other Tourette patients or spontaneous movements of healthy subjects were presented to Tourette patients and healthy subjects. Participants' responses were assessed using blinded review of video recordings by 2 independent raters and related to stimuli presented. RESULTS: Both raters detected more echoes in patients. In a permutation analysis, no healthy subject had echoes above chance level. In contrast, 6 and 5 patients were classified as echoers according to rater 1 and rater 2, respectively, in 1 analysis, and 9 patients were so classified in a second analysis (according to rater 2 only). Concordance between raters was high. Patients echoed both following stimuli showing tics and following stimuli showing spontaneous movements. Most echoes were part of patients' individual tic repertoire. CONCLUSIONS: Echopraxia is a hallmark of Tourette syndrome.

Age interferes with sensorimotor timing and error correction in the supra-second range.

Introduction: Precise motor timing including the ability to adjust movements after changes in the environment is fundamental to many daily activities. Sensorimotor timing in the sub-and supra-second range might rely on at least partially distinct brain networks, with the latter including the basal ganglia (BG) and the prefrontal cortex (PFC). Since both structures are particularly vulnerable to age-related decline, the present study investigated whether age might distinctively affect sensorimotor timing and error correction in the supra-second range. Methods: A total of 50 healthy right-handed volunteers with 22 older (age range: 50-60 years) and 28 younger (age range: 20-36 years) participants synchronized the tap-onsets of their right index finger with an isochronous auditory pacing signal. Stimulus onset asynchronies were either 900 or 1,600 ms. Positive or negative step-changes that were perceivable or non-perceivable were occasionally interspersed to the fixed intervals to induce error correction. A simple reaction time task served as control condition. Results and Discussion: In line with our hypothesis, synchronization variability in trials with supra-second intervals was larger in the older group. While reaction times were not affected by age, the mean negative asynchrony was significantly smaller in the elderly in trials with positive step-changes, suggesting more pronounced tolerance of positive deviations at older age. The analysis of error correction by means of the phase correction response (PCR) suggests reduced error correction in the older group. This effect emerged in trials with supra-second intervals and large positive step-changes, only. Overall, these results support the hypothesis that sensorimotor synchronization in the sub-second range is maintained but synchronization accuracy and error correction in the supra-second range is reduced in the elderly as early as in the fifth decade of life suggesting that these measures are suitable for the early detection of age-related changes of the motor system.

Cathodal Transcranial Direct Current Stimulation (tDCS) Applied to the Left Premotor Cortex Interferes with Explicit Reproduction of a Motor Sequence.

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that allows the modulation of cortical excitability. TDCS effects can outlast the stimulation period presumably due to changes of GABA concentration which play a critical role in use-dependent plasticity. Consequently, tDCS and learning-related synaptic plasticity are assumed to share common mechanisms. Motor sequence learning has been related to activation changes within a cortico-subcortical network and findings from a meta-analysis point towards a core network comprising the cerebellum as well as the primary motor (M1) and the dorsolateral premotor cortex (dPMC). The latter has been particularly related to explicit motor learning by means of brain imaging techniques. We here test whether tDCS applied to the left dPMC affects the acquisition and reproduction of an explicitly learned motor sequence. To this end, 18 healthy volunteers received anodal, cathodal and sham tDCS to the left dPMC and were then trained on a serial reaction time task (SRTT) with their right hand. Immediately after the training and after overnight sleep, reproduction of the learned sequence was tested by means of reaction times as well as explicit recall. Regression analyses suggest that following cathodal tDCS reaction times at the end of the SRTT training-block explained a significant proportion of the number of correctly reported sequence items after overnight sleep. The present data suggest the left premotor cortex as one possible target for the application of non-invasive brain stimulation techniques in explicit motor sequence learning with the right hand.

Functional network interactions during sensorimotor synchronization in musicians and non-musicians.

Precise timing as determined by sensorimotor synchronization is crucial for a wide variety of activities. Although it is well-established that musicians show superior timing as compared to non-musicians, the neurophysiological foundations - in particular the underlying functional brain network - remain to be characterized. To this end, drummers, professional pianists and non-musicians performed an auditory synchronization task while neuromagnetic activity was measured using a 122-channel whole-head magnetoencephalography (MEG) system. The underlying functional brain network was determined using the beamformer approach Dynamic Imaging of Coherent Sources (DICS). Behaviorally, drummers performed less variably than non-musicians. Neuromagnetic analysis revealed a cerebello-thalamo-cortical network in all subjects comprising bilateral primary sensorimotor cortices (S1/M1), contralateral supplementary motor and premotor regions (SMA and PMC), thalamus, posterior parietal cortex (PPC), ipsilateral cerebellum and bilateral auditory cortices. Stronger PMC-thalamus and PPC-thalamus interactions at alpha and beta frequencies were evident in drummers as compared to non-musicians. In professional pianists stronger PMC-thalamus interaction as compared to non-musicians at beta frequency occurred. The present data suggest that precise timing is associated with increased functional interaction within a PMC-thalamus-PPC network. The PMC-thalamus connectivity at beta frequency might be related to musical expertise, whereas the PPC-thalamus interaction might have specific relevance for precise timing.

Altered pattern of motor cortical activation-inhibition during voluntary movements in Tourette syndrome.

In patients with Gilles de la Tourette syndrome (GTS) alterations of motor cortex (M1) excitability at rest have been evidenced. In contrast, there has so far been little research into changes of motor cortical reactivity during the time course of voluntary movements in GTS patients. The present study investigates neuromagnetic event-related desynchronization (ERD) and event-related synchronization (ERS) of bilateral M1 in 11 GTS patients and 11 healthy control subjects. ERD represents motor cortical activation, whereas ERS most likely indicates its inhibition. Subjects performed a self-paced finger movement task while magnetoencephalography was used to record neuromagnetic activity. In GTS patients, ERD at beta frequency was significantly increased in the contralateral hemisphere before and during movements, whereas ERS following movement termination was increased in M1 ipsilateral. Ipsilateral ERS was inversely correlated with tic severity as determined by the Yale Global Tic Severity Rating Scale. The data of the present study support the hypothesis that during voluntary movements, motor cortical reactivity is pathologically altered in GTS patients. The observed pattern of increased activation (ERD) prior to and during movement execution followed by increased inhibition (ERS) after movement termination at beta frequency suggests abnormally increased motor cortical activation, possibly driving stronger inhibition. The stronger this inhibition is, the better symptoms appear to be controlled.

The posterior parietal cortex mediates early offline-rather than online-motor sequence learning.

Learning of new motor skills occurs particularly during training on a task (i.e. online) but has been observed between training-blocks lasting up to days after the end of the training (i.e. offline). Offline-learning occurs as further improvement in task performance indicated by increased accuracy and/or faster responses as well as less interference with respect to a distracting condition. Successful motor learning requires the functional interplay between cortical as well as subcortical brain areas. While the involvement of the primary motor cortex in online-as well as early offline-learning is well established, the functional significance of the posterior parietal cortex (PPC) is less clear. Since the PPC may act as sensory-motor interface, a causal involvement in motor learning is conceivable. In order to characterize the functional significance of the left PPC for motor sequence learning, transcranial direct current stimulation (tDCS) was applied either immediately prior to, during or immediately after training on a serial reaction time task (SRTT) in a total of 54 healthy volunteers. While the analysis did not provide evidence for a significant modulation of reaction times during SRTT training (i.e. online-learning), cathodal tDCS decelerated reaction times of the learned sequences as compared to anodal and sham stimulation 30 min after the end of training. The findings suggest that cathodal tDCS over the left parietal cortex interferes with the reproduction of learned sequences.

Modality specific functional interaction in sensorimotor synchronization.

Movement execution strongly relies on precise sensorimotor synchronization. In a finger-tapping task that requires subjects to synchronize their finger taps to regular pacing signal synchronization accuracy varies with respect to pacing signal's modality. This study aimed at elucidating functional brain dynamics associated with modality specific behavioral synchronization accuracy. To this end, 10 right-handed subjects performed a finger-tapping task with respect to regular auditory and visual pacing, respectively, whereas neuromagnetic activity was recorded using a 122-channel whole-head neuromagnetometer. Visual pacing was associated with significantly reduced tap-to-pacer asynchrony and increased intertap variability as compared to auditory pacing. The brain dynamics associated with task execution were analyzed using the frequency domain beamformer approach dynamic imaging of coherent sources (DICS). Both tasks were shown to be associated with comparable networks. However, during visual pacing involvement of the ventral premotor cortex (PMv) was shown, whereas during auditory pacing the dorsal premotor cortex (PMd) was concerned with task execution. Synchronization with respect to visual pacing was associated with significantly increased functional interaction between thalamus and PMv at beta frequency as compared to functional interplay between thalamus and PMd during auditory pacing. Auditory synchronization was associated with increased functional interaction between left superior temporal gyrus and PMd at alpha frequency. Furthermore, functional interaction between thalamus and premotor cortex at beta frequency was significantly correlated with synchronization accuracy. All in all the present data suggest that modality specific synchronization differences are associated with frequency and connectivity specific changes of functional interaction in distinct brain networks.

Levodopa affects functional brain networks in Parkinsonian resting tremor.

Resting tremor in idiopathic Parkinson's disease (PD) is associated with an oscillatory network comprising cortical as well as subcortical brain areas. To shed light on the effect of levodopa on these network interactions, we investigated 10 patients with tremor-dominant PD and reanalyzed data in 11 healthy volunteers mimicking PD resting tremor. To this end, we recorded surface electromyograms of forearm muscles and neuromagnetic activity using a 122-channel whole-head magnetometer (MEG). Measurements were performed after overnight withdrawal of levodopa (OFF) and 30 min after oral application of fast-acting levodopa (ON). During OFF, patients showed the typical antagonistic resting tremor. Using the analysis tool Dynamic Imaging of Coherent Sources, we identified the oscillatory network associated with tremor comprising contralateral primary sensorimotor cortex (S1/M1), supplementary motor area (SMA), contralateral premotor cortex (PMC), thalamus, secondary somatosensory cortex (S2), posterior parietal cortex (PPC), and ipsilateral cerebellum oscillating at 8 to 10 Hz. After intake of levodopa, we found a significant decrease of cerebro-cerebral coupling between thalamus and motor cortical areas. Similarly, in healthy controls mimicking resting tremor, we found a significant decrease of functional interaction within a thalamus-premotor-motor network during rest. However, in patients with PD, decrease of functional interaction between thalamus and PMC was significantly stronger when compared with healthy controls. These data support the hypothesis that (1) in patients with PD the basal ganglia and motor cortical structures become more closely entrained and (2) levodopa is associated with normalization of the functional interaction between thalamus and motor cortical areas.

Pre-stimulus beta power modulation during motor sequence learning is reduced in 'Parkinson's disease.

Beta oscillations within motor-cortical areas have been linked to sensorimotor function. In line with this, pathologically altered beta activity in cortico-basal ganglia pathways has been suggested to contribute to the pathophysiology of Parkinson's disease (PD), a neurodegenerative disorder primarily characterized by motor impairment. Although its precise function is still discussed, beta activity might subserve an anticipatory role in preparation of future actions. By reanalyzing previously published data, we aimed at investigating the role of pre-stimulus motor-cortical beta power modulation in motor sequence learning and its alteration in PD. 20 PD patients and 20 healthy controls (HC) performed a serial reaction time task (SRTT) in which reaction time gain presumably reflects the ability to anticipate subsequent sequence items. Randomly varying patterns served as control trials. Neuromagnetic activity was recorded using magnetoencephalography (MEG) and data was reanalyzed with respect to task stimuli onset. Assuming that pre-stimulus beta power modulation is functionally related to motor sequence learning, reaction time gain due to training on the SRTT should vary depending on the amount of beta power suppression prior to stimulus onset. We hypothesized to find less pre-stimulus beta power suppression in PD patients as compared to HC associated with reduced motor sequence learning in patients. Behavioral analyses revealed that PD patients exhibited smaller reaction time gain in sequence relative to random control trials than HC indicating reduced learning in PD. This finding was indeed paralleled by reduced pre-stimulus beta power suppression in PD patients. Further strengthening its functional relevance, the amount of pre-stimulus beta power suppression during sequence training significantly predicted subsequent reaction time advantage in sequence relative to random trials in patients. In conclusion, the present data provide first evidence for the contribution of pre-stimulus motor-cortical beta power suppression to motor sequence learning and support the hypothesis that beta oscillations may subserve an anticipatory, predictive function, possibly compromised in PD.

The effect of rTMS over left and right dorsolateral premotor cortex on movement timing of either hand.

It has been suggested that the left dorsolateral premotor cortex (dPMC) controls timing abilities of either hand. To further clarify its functional significance for movement timing, low-frequency repetitive transcranial magnetic stimulation (rTMS) was applied over the left and right dPMC, respectively, while subjects performed an auditorily paced finger-tapping task with each hand. rTMS over the left dPMC decreased tapping accuracy of both hands, whereas no behavioural effects occurred following right dPMC stimulation. To elucidate the time window in which left dPMC TMS disturbs synchronization abilities, pairs of TMS pulses were applied over the left dPMC and the left anterior parietal cortex serving as control condition. TMS pulses were applied randomly at 40 ms, 80 ms, 120 ms, 160 ms, 200 ms and 240 ms before pacer onset, as taps precede the pacing signal for about 20-60 ms. Again, the analysis revealed that TMS over the left dPMC disturbed synchronization abilities of either hand; however, this effect was shown at different times suggesting that the left dPMC affects the right M1 via at least one additional relay station. The present data support the hypothesis that the left dPMC is crucial for accurate timing of either hand. Additionally, they reveal a piece of evidence that the left dPMC affects the left hand not via a direct left dPMC-right M1 connection.

Differential effects of levodopa and subthalamic nucleus deep brain stimulation on bradykinesia in Parkinson's disease.

Cardinal symptoms of Parkinson's disease (PD) respond well to treatment with levodopa and deep brain stimulation (DBS) of the subthalamic nucleus (STN). However, it has remained unclear whether levodopa and STN-DBS have differential effects on bradykinesia. We investigated 8 PD-patients with STN-electrodes in four conditions: STN-DBS and levodopa (ON(MED)/ON(STIM)), STN-DBS only (OFF(MED)/ON(STIM)), levodopa only (ON(MED)/OFF(STIM)), without STN-DBS/levodopa (OFF(MED)/OFF(STIM)). Fourteen volunteers served as controls. Subjects performed fastest possible (1) pronation/supination of the forearm (diadochokinesia) and (2) flexion and extension of the index finger (finger movements). Movements were recorded using a 3D-ultrasound-system. Maximum frequency, amplitude, and smoothness of movements were determined. During OFF(MED)/OFF(STIM), all parameters were worser than in all other conditions. In proximal diadochokinesia, OFF(MED)/ON(STIM) significantly improved the amplitude and frequency, whereas ON(MED)/OFF(STIM) had no significant effect. In contrast, we found a stronger effect of levodopa (ON(MED)/OFF(STIM)) on amplitudes of distal finger movement than on amplitudes of diadochokinesia. Combination of treatments during ON(MED)/ON(STIM) further improved both movements. However, maximum frequency remained lower in PD-patients during ON(MED)/ON(STIM) compared with controls. This study demonstrates a better effect of levodopa on distal finger movements and STN-DBS on proximal diadochokinesia. Furthermore, a complementary effect of both therapies on brain areas involved in bradykinesia can be assumed.

Effects of tDCS on Bimanual Motor Skills: A Brief Review.

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that allows the modulation of cortical excitability as well as neuroplastic reorganization using a weak constant current applied through the skull on the cerebral cortex. TDCS has been found to improve motor performance in general and motor learning in particular. However, these effects have been reported almost exclusively for unimanual motor tasks such as serial reaction time tasks, adaptation tasks, or visuo-motor tracking. Despite the importance of bimanual actions in most activities of daily living, only few studies have investigated the effects of tDCS on bimanual motor skills. The objectives of this review article are: (i) to provide a concise overview of the few existing studies in this area; and (ii) to discuss the effects of tDCS on bimanual motor skills in healthy volunteers and patients suffering from neurological diseases. Despite considerable variations in stimulation protocols, the bimanual tasks employed, and study designs, the data suggest that tDCS has the potential to enhance bimanual motor skills. The findings imply that the effects of tDCS vary with task demands, such as complexity and the level of expertise of the participating volunteers. Nevertheless, optimized stimulation protocols tailored to bimanual tasks and individual performance considering the underlying neural substrates of task execution are required in order to probe the effectiveness of tDCS in greater detail, thus creating an opportunity to support motor recovery in neuro-rehabilitation.

Anodal Transcranial Direct Current Stimulation (tDCS) Over the Right Primary Motor Cortex (M1) Impairs Implicit Motor Sequence Learning of the Ipsilateral Hand.

Motor sequence learning is associated with the activation of bilateral primary motor cortices (M1). While previous data support the hypothesis that the contralateral M1 is causally involved in the acquisition as well as early consolidation of a motor sequence, the functional significance of the ipsilateral M1 has yet to be solved. Transcranial direct current stimulation (tDCS) allows the non-invasive modulation of cortical excitability. Anodal tDCS applied to the left M1 has been shown to facilitate implicit motor sequence learning of the right hand most likely due to increased excitability. The present study aims at characterizing the functional contribution of the ipsilateral (right) M1 on implicit motor sequence learning of the right hand. To this end, 24 healthy, right-handed subjects received anodal and sham tDCS to the right M1 in a counterbalanced order. Stimulation started 8 min prior to training on a variant of the serial reaction time task (SRTT) with the right hand and persists over the entire training period. The SRTT comprised a fixed eight-digit sequence. A random pattern served as control condition. Reaction times were assessed before and at the end of the acquisition (EoA) immediately after training on the SRTT. The analysis revealed significantly faster reaction times of both hands independent of tDCS condition in sequential trials. However, the gain of reaction times was significantly smaller following anodal as compared to sham tDCS. The data suggest that anodal tDCS applied to the right M1 impairs implicit motor sequence learning of both hands. The underlying mechanism likely involves alterations of the interaction between bilateral M1.